Mental health professionals from Denver to Glenwood Springs to Aspen say there was a slowdown in the demand for therapy just after the onset of the COVID-19 crisis seven weeks ago.

But, they also point out, demand began rising in April, and even busier times may lie just around the corner for counselors as local governments lift stay-at-home restrictions, more businesses reopen and individuals attempt to navigate their way through the uncertain landscape of a “new normal” way of life created by the global pandemic.

Friday not only was the first day of May, it marked the start of “Mental Health Awareness Month,” which has been observed in the United States for seven decades. In Denver on Friday, state officials joined other industry professionals in recognizing the need to protect and promote mental health resources as the physical health threat from the novel coronavirus subsides — hopefully — as a result of government-mandated strategies involving social distancing, business closures and relative isolation.

“In the midst of this global pandemic, we are all facing many uncertainties,” said Vincent Atchity, president and CEO of statewide advocacy group Mental Health Colorado. “But what is certain is that all Coloradans, and everyone in the world, now have a much keener awareness of the fact that our mental and our physical health are closely connected.

“We also know that the people for whom Mental Health Colorado has advocated … will be feeling the consequences of this pandemic more painfully than others, making our advocacy work more important as we head into the second half of the year,” he continued.

However, in the same online gathering, Michelle Barnes, executive director of the Colorado Department of Human Services, pointed out that one need not have a diagnosed mental health condition to be struggling during this time.

“We are all struggling right now,” Barnes said.

Last week, the Aspen Daily News reached out to Atchity and mental health professionals in the Roaring Fork Valley for their thoughts on the effect of the COVID-19 crisis on the community’s mindset, coping strategies and the resources that may be available to those in need.

Local therapist Christina M. King says a positive way to handle the COVID-19 crisis would be to see it as an opportunity to make self-improvements and to connect with others in more meaningful ways.

Courtesy photo

Christina M. King, an Aspen counselor specializing in cognitive behavioral therapy — and founder of the mental health advocacy nonprofit Aspen Strong — said there is no doubt most everyone’s mental health has been “challenged,” regardless of whether people are still working their regular jobs, working with children at home, working remotely with no human contact (aside from an online meeting) or not working.

The challenges can be effectively addressed, she said, despite the current stresses and the uncertainties of the future.

“We are in a crisis, but we do not have to be in crisis mode,” King said. “We can react to this or we can respond to it.”

Opportunity for growth

King said in overcoming the challenges of the times, it may be important to understand how the brain works.

“We’re wired for connection,” she said, adding that in order for humans to “self-regulate,” the four S’s typically come into play.

“We need to feel safe, seen, soothed and secure,” King explained. “Simply, the word ‘pandemic’ itself is fear-driven. So that’s an emotional threat and possibly a physical threat for some of us. For the longevity of this, it’s going to be an emotional threat. We’re going to be pushed into this survival instinct: fight, flight or freeze.”

But people have a choice to step back and not go into “survival mode,” opting for a healthier option.

“Situations in life do not create pain or sadness or disappointment or anxiety,” King said. It’s our interpretations of a situation that causes those feelings. Our job is to break down those interpretations and ask, ‘Is this realistic? Is it rational? Does it serve me to continue to be in this state of mind and feel this way?’”

The key to overcoming those negative feelings caused by interpretations is to work through them, King said. That can be handled in a variety of ways: writing down thoughts, meditating, talking with family, friends and co-workers — or visiting a mental health provider.

“Make a choice: Do I want to stay here, or do I want to be in a different mindset?” King said.

She believes the gradual reopening of society and the economy will eventually support overall health: financial, emotional, spiritual and physical.

“Yet, that is also determined by each individual,” she said. “Some people can continue to act in crisis mode when they go back to work. As a community, or as an individual, we need to think about where we are at and break this down. How have we been, how are we right now and how do we want to be?”

Hiking local trails and taking time to stop and admire nature, such as this wildflower photographed on a recent afternoon, are among the many coping mechanisms recommended by public health entities and mental health providers amid the COVID-19 pandemic and its effect on the well-being of communities everywhere.

She used the analogy of when a parent dies, the son or daughter is so busy making arrangements and handling various family affairs, the grief process is delayed.

“And at some point, when the funeral is over and a month goes by, we are crying our eyes out,” she said. “I think it’s predictable for our bodies to want to get out of ‘fight, flight or freeze’ to sort of just have this powerful emotional experience.”

That type of response can be a good outlet for people, but it also can be a scary “emotional explosion” for people who aren’t used to having such feelings, King said. A better way to handle the COVID-19 crisis would be to see it as a chance to make improvements in life and to connect with others in more meaningful ways.

“The perspective I would like to impress upon people is that this is an opportunity for growth and for change, and for seeing and hearing differently than we’ve ever seen and heard before,” she said.

It’s healthy to feel, especially in myriad ways, King said. She recently read that statistically, people across the world identify their emotions with three words — happy, sad and “pissed off.”

“If we really want to be the resilient humans that we are capable of being, we need more feelings in our emotional tool kit,” she said. “If I only had three words to describe my [condition] when I walk into a doctor’s office with an eye infection, I don’t know if they’re going to be able to help me in the best way. Our emotional literacy is what’s going to allow us to be as resilient as we can be.”

Plea for compassion

Glenwood Springs-based Mind Springs Health is one of many valley nonprofits engaged in behavioral-health services that’s doing as much as it can to assist those in need during the crisis, according to clinical operations manager Jacque Skramstad.

Jacqueline Skramstad, clinical operations manager for Mind Springs Health, says all of the nonprofit’s usual offerings are available to those who need them. Some counseling sessions are provided online.

Courtesy photo

All offices, and the services within those offices, are open and doing business, albeit some of the duties, including outpatient counseling, are handled via the online ZOOM platform or by telephone, she said.

“We were able to get all of our staff up to speed really quickly,” Skramstad said of the adjustments.

The nonprofit’s facilities include West Springs Hospital in Grand Junction, detox facilities in Frisco and Grand Junction, and the residential Women’s Recovery Center also in Grand Junction. All have remained open, she said. Mobile crisis services continue via televideo or in-person services.

“Everything remains open, although some services have more of a virtual platform than others,” she said.

While Mind Springs continues to serve its regular clients, the mental health service provider also is involved in serving the community at large. To that end, a live, informative Facebook series called “Peace in the Pandemic” was launched in March.

“We’ve had multiple offerings per week but the recordings are on our Facebook page for those who want to go back and watch them,” Skramstad said.

The nonprofit’s website has a comprehensive COVID-19 resource section as well, accessible through this link: mindspringshealth.org/treatment-services/covid19resources/. There, one can gain access to various services offered by municipalities and counties, as well as those provided by the state and federal governments. Traffic to the website and Facebook page has been picking up in recent weeks, a sign that people are becoming hungrier for information.

A 24/7 COVID-19 support line, 877-519-7515, has been established just for people who need someone to talk with.

“It’s not for people with acute stress, it’s for people who are struggling and just need someone to talk to, and they can get tips on coping skills and connections about other resources that are available in the community,” Skramstad said. “It’s really a good place for people to start to get some support and help. You don’t have to be a client to call.”

A nonprofit with operations in 10 counties across western Colorado, Mind Springs Health has been holding live “Peace in the Pandemic” events on Facebook to share coping strategies and promote mental health services.

Courtesy Mind Springs Health

Mind Springs also has been distributing fliers in English and Spanish that list contact information for certain services. About 1,000 fliers have been distributed at Roaring Fork Valley food drives.

Skramstad said the nonprofit saw a dramatic decrease in formal service requests when public health orders in the region were first issued in mid-to-late March. She believes that was a case of people thinking the crisis would be short-lived and so they didn’t yet feel the need to seek help.

While the floodgates have yet to open, “we expect an uptick in demand soon,” she said, adding that it’s becoming clear that the effects of the pandemic are going to continue for many months.

People are wrestling with depression and anxiety, but a lot of clients have other longstanding mental health issues that are being exacerbated by the coronavirus crisis, Skramstad said.

While Mind Springs ramped up its telehealth services amid public health stay-at-home orders designed to keep people from moving around the area, she said she expects in-office therapy to resume soon as counties shift to different orders that aren’t as stringent.

Financial barriers to therapy are being resolved valleywide, she said, through partnerships among providers such as Mind Springs, Aspen Strong and Aspen Hope Center. Mind Springs takes Medicaid and private insurance, and utilizes a sliding-scale fee system for the uninsured.

“Some of the other valley providers take private insurance as well,” she said. “[Lack of] money shouldn’t be a barrier.”

Skramstad said it’s important for everyone to have compassion and grace for others in the community, as well as for themselves.

“Everyone is doing the best that they can,” she said. “Everybody copes with stress differently.”

Rest is vitally important to good mental health, Skramstad added. Using drugs or alcohol as a coping mechanism is a bad idea, for many reasons, but in part because it can negatively impact sleep.

“When you don’t get enough sleep you are more irritable,” she said.

‘Storm of concerns’

Discussing the COVID-19 situation on the day before he participated in Friday’s virtual meeting of officials to promote mental health awareness, Atchity said Mental Health Colorado has two broad areas of primary concern.

The first is for people already living with mental health conditions who may be abusing substances. “Our concern for them has always been that access to care is limited,” he said. “A lot of people fall through gaps in a faulty system of care and end up suffering extreme consequences from unmanaged mental health, and those people are at even greater risk now that we have such limitations on our ability to get out and obtain access to care.”

At the same time, behavioral-health providers across the state have been working since state stay-at-home orders were issued in March to increase access to care through telehealth services — a much-welcomed move, Atchity said.

“People who are already struggling often depend on whole networks of support that are disrupted thanks to this isolation that we’re practicing,” he said.

The second category of concern relates to people who may never have had serious mental health concerns, or perhaps never thought about their mental health. Suddenly, given worries over contracting a potentially fatal disease, “that takes a toll on your mental health,” Atchity said.

“The uncertainty that we’re living with, regarding not knowing when or how this is going to end, and watching the economy take this downturn and the surge in unemployment, and the consequent instability of individuals and families that comes along with that — this is a storm of mental health concerns that is new to many, and it will take a toll down the line,” he said.

Atchity said it’s too early to say whether the crisis will lead to an even higher suicide rate in a state where many communities are already experiencing high rates. The official data on suicides tends not to present itself for many months, he pointed out.

Vincent Atchity, president and CEO of the nonprofit Mental Health Colorado, top left, participates in an online gathering of state and mental health officials on Friday to promote May as “National Mental Health Awareness Month.”

Screenshot via ZOOM

“County coroners don’t release their reports that quickly,” he said. “We can only track suicides in the big picture several months down the line.”

He’s hearing anecdotal information across the state about increases in domestic violence but a decline in reported incidences of child abuse.

“That’s concerning, because we don’t know what confinement is doing with regard to families and stressors that create those kinds of dynamics that can lead to abuse,” Atchity said. “And since the kids aren’t out in schools where there are mandated reporters with eyes on them, that’s an explanation behind why the number of reported cases of abuse may have gone down.”

He said he understands that retail alcohol sales have risen dramatically since mid-March at the state and national level, which could mean an increase in alcohol abuse.

“That comes as no surprise; there seems to be a prevalent culture of self-medication with alcohol as a survival strategy across social media, and other cultural expressions of that,” Atchity said. “Alcohol is the most harmful substance we have. We often overlook that as the ‘elephant in the room.’”

On a positive note, telehealth services are being embraced by mental health providers, he said, whereas previously there was reluctance on their behalf to try it. Often, providers cited regulatory or bureaucratic hurdles as reasons why they couldn’t expand mental health services in that way.

But with COVID-19, some of those rules have been relaxed, “and in nearly every community provider organizations have stepped up almost overnight to provide remote access to care,” Atchity said. “If that is working for people, that is a very promising sign, as it’s better to meet with a therapist virtually than not at all if somebody has that need.”

Financial barriers to mental health services remain a reality for many low-income residents. The Colorado General Assembly voted last year to put more teeth behind enforcement of the nation’s “parity law” that requires insurance companies to cover mental health in the same manner as physical health, he said. But implementation of the state measure is behind schedule.

Atchity said he believes the lifting of stay-at-home orders and the reopening of the economy could contribute artificially to better mental health, at least in the beginning.

“It’s hard to tell,” he said. “There may be some increased need for mental health services as the consequences of the economy start playing themselves out in people’s lives. And there may be an increased need on the part of folks who have been providing health care in the pandemic to people with the virus. The providers themselves may need to process this with some clinical assistance.”

However, if the decisions designed to restart the economy this month end up resulting in a new wave of coronavirus spread, the effects on physical and mental health being experienced today could continue for quite some time.

“There’s not a cure and there’s not a vaccine,” Atchity said. “People who are already inclined to be a little bit dismissive of the stay-at-home orders may get casual and sloppy, and we could see a resurgence of this in pretty short order.

“It’s going to be a tricky balance of trying to be more economically active without being foolish. This could drag out … and that will take another toll on people’s mental health.”